For psychiatry "bible," Asperger's is out, binge eating is in

The Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, will no longer classify Asperger's as an official mental disorder, but binge eating and hoarding are now in. The board of the American Psychiatric Association voted these and other changes in to the trade "bible" on Saturday. Asperger's is now relegated to a subset of autism.


    1. Well, from what I understand it’s been replaced with a catch all for “autism spectrum disorders” so it’s still fuzzy — perhaps even fuzzier — but hopefully less arbitrary.

  1. Aspergers is now moved to a be included in Autism Spectrum Disorder.  Do you feel like this is denying agency to people with Aspergers because they no longer have a separate word in the DSM?  Is that where your outrage comes from?  They’ll still have a medical diagnosis… this isn’t about denying mental health care.

          1. No, between the “Asperger’s is out” headline and the  “relegated to a subset” statement there’s certainly a negative framing of this story.  And I’m curious if Xeni framed this negatively because she believes people with Aspergers are being denied agency or for some other reason.

            But thanks for your criticism.

          2.  It has been relegate to a subset of a larger category. Any strong emotional content attached to that is entirely on the reader.

          3. Yes, and she has chosen the most succinct, straightforward words to describe the changes to the document. There is no negativity, and certainly no outrage present in the post.

          4. Well I think somebody who only reads the headline could mistakenly take away from this that the psychiatric profession is dismissing people with Aspergers. And I don’t think of “relegated” as particularly neutral. But ok, you see it differently. 
            I remain curious as to if and why the author may view this change to the DSM as negative, which was why I wrote my comment.  I’m interested.

          5. I don’t take it that way. Relegated just means demoted. It is neutral in and of itself. I don’t think she’s implying it denies anyone anything. To be honest I doubt, from other posts she has written, that she puts *that* much stock in the DSM.It is fluid and subjective, and if there seems to be any snark it is in the use of the word “bible” there.

          6.  Another vote for “tripping”.  If there’s any “negative framing” in the OP, it would seem to me to be more based on the arbitrariness with which psych/ologists/iatrists decide diagnoses are valid or invalid.

  2. Luckily, we can just include ‘DSM Declassification Disorder’ and ‘DSM Reclassification Syndrome Not Otherwise Specified’ in the DSM 6 to help everybody who didn’t like the DSM 5…

  3. “Relegated” seems like the wrong term to use. Obviously, we’re not doctors but, so long as this doesn’t affect the care of those considering in the spectrum range, I see this as a good thing. Binge eating and hoarding sound very different from, from what I’ve read and understand about Asperger’s, a physical difference in brain chemistry. One is a relative OCD, the other a physical inability communicate that isn’t a motor skill issue. The former treatable with chemical and talk therapy and the later requires something more – something we haven’t fully identified.

  4. The important bit to remember is that the DSM is not infallible. It’s a guidebook and using the term “bible” to describe it, even in jest, just lends more credence to it than it needs.  

    1.  It’s not like the Bible is infallible or anything. To some, using the term “bible” to describe DSM might be unnecessarily pejorative.

      1. I like to use the Bible for differential spiritual diagnosis.  “Let’s see what Matthew has to say about this.  Deuteronomy gave a suck ass answer to that question.”

    2. It’s a classification index for medical insurance billing and qualification for services and assistance. It helps in tracking stats and trends as well.

      It is quite useful for that, but I assume a good practitioner notes DSM codes as elements of diagnosis and rough reference points, not like a culture coming up positive for a specific bacteria.

      Note that I specified a “good” practitioner. There are lots and lots of lazy doctors of all specialties, mental health no exception.

      1. Based on the price delta (unless you have the fancy insurance) between getting your general MD to write the prescription that he is just as legally qualified as any other doctor to write and getting some nontrivial shrink time, I suspect that more than laziness may be behind a lot of the low quality diagnostic work in psychology and psychiatry…

        1. Having worked in the field on and off for more than a decade (I much prefer my university lab than client work most of the time as I have a tendency of taking others problems home), a lot of it has to do with the fact that most MDs consider psychological affectations to be medical in nature as opposed to mental.  I.e., the chemistry changes the behavior vs. behavior changes the biology.  In most cases, the biology changes as a result of the need for homeostasis and not the other way around.  However, coming from a family of physicians and surgeons…and having to get accepted to medical school before being ‘permitted’ to finalize the PhD in psychology…I can certainly tell you there is a strong bias against what psychologists do and why they do it.

          And from my experience, most physicians feel the same.

          Beyond that, in the MD world, psychiatry is considered a fall back field like GP or pediatrics.  It is an area you go into if you are not qualified to do more.  Honestly, I think the only reason I got an acceptance letter was because when the admissions committee saw my background in psychology because my scores were not that good.  

          But the big reason for MDs being lazy is that they approach mental disorders as physical ones.  Not all…but it is the prevailing belief.

          That said, the whole argument about the general public being outraged against changing diagnoses still surprises me.  Honestly, the clinical diagnosis does very little for anyone except the clinician…people are either in worry about being labeled or wanting a label so they can continue unchecked.  For some reason, no one seems to be upset about the Schizo line being condensed and formally put on a spectrum.  I guess schizoaffective isn’t a politically correct classification that anyone cares about.  I find the general public commenting on changes in a (mostly) scientific field to be as relevant as rich conservative men telling poor liberal women what they can and can’t do with their bodies.  Let the scientists and theorists deal with their job and stop trying to make it political.  

          1. Other people have a different take on this whole situation.  Some people LIKE the idea of studying the brain, so they go into the psychological and brain sciences, rather than neurology and brain sciences.  That’s because they want to track how behaviors and physiology work together.  So, I wouldn’t be so quick to throw all of your colleagues under the bus.

          2. How did I throw anyone under the bus?  I specifically said that not all were this way, but it is a prevailing belief.

            That said, I do believe that there are certain impairments that are more biological in nature than others.  However, the vast majorities of depression and other ailments that MDs see are.  For some reason, they try to treat the things like this that they have no right to do so, and are willing to pass the real biological cases to specialists.  Minimizing the profession.

            I wish there were more people studying the harder sciences of seeing how the biology fits the mental models.  It is exactly what I did.  To be a psychologist, one doesn’t need anatomy or neurobio or even much more than the basic chemistries.  I have a lot of complaint about my chosen field, but the comment was about MDs treating illnesses with meds and being lazy…

          3. Let the scientists and theorists deal with their job and stop trying to make it political. 

            Psychologists take it upon themselves to define “normal” for a given society and then demand that people “stop making [psychology] political?  There is no way to avoid making psychology political.  It scares the shit out of me when psychologists fail to see this.  If you’re going to play at being High Priest of Mental Health I think you need to engage in some serious reflection on your role in society and what it really means.

            Also, not so sure about the “(mostly)” in “(mostly) scientific”. Compromise and say “half”?

  5. I’m glad that binge eating disorder will be an “official” diagnosis. I’ve worked with people who fit these criteria and hopefully this will lead to more research into treatment (although there already is quite a good treatment protocol for binge eating). Hoarding disorder is more contentious. I work in an older person’s psychiatric service and we have the odd hoarder (some have more than one home filled to the brim. A lifetime is a long time to hoard). They generally don’t fit into any diagnostic category. I wonder if this new disorder will be pushed by urban authorities who sometimes want the ability to clean up a person’s property for public image/safety issues – often against the person’s will. A disorder could be used to push this case further. I wonder how it will play out.

  6. I went to a two day course for parents of teenagers with autism a couple of years ago, and one of the very first things the teacher said was that the specific diagnosis is not important. Our kids would be diagnosed with Asperger’s, infantile  autism or PPD-NOS, she said, but it’s basically the same spectrum and the same things we needed to understand about how we can expect them to think.

    In that sense, it makes sense to avoid the proliferation of diagnoses. Asperger’s has been used (at least here) mainly for “high-functioning” indivuduals, but maybe that distinction could be allowed withing the autism diagnosis. Having too many pigeonholes for similar people can be misleading.

    1. Except when that person goes to get a job. “I’m autistic” might get a different response from an employer than, “I have Asperger Syndrome.”

      1. My own experience with employers is that “…autistic…” and “…autism spectrum…” elicits an assumption of below-average intelligence and/or hissy fits ala Rain Man — while “…Asperger’s…” elicits a look of bewilderment and an ignorance of the term.

        It was a strange day, the day I realised that many people view learning new things as a kind of burden, rather than an exciting opportunity.

        1. The reason for that is that until quite recently the difference between autism and an autism-spectrum diagnosis was very much just a “has learning disability” checkbox in the symptoms.
          Autism now just requires a language impairment/delay rather than outright developmental retardation, but public consciousness will be fixated on Rain Man-level autism as ‘real autism’ for quite some time as those are its most visible sufferers.

        1. That’s somewhat problematic if you have responses that are clearly non-neurotypical. I don’t deny the bigotry, but on the whole, it would seem better to have a potential employer know what’s up with you rather than leave the interview with him or her saying, “WTF is up with that guy?”

  7. Binge eating and hoarding have both had reality shows focused on them but not Aspeger’s, and so it has been relegated to the trash heap of less commercially exploitable disorders. DSM via MTV.

    1. It’s true.  Autistic people are on a strange scale, ranging from totally non-functioning to super-human.  I mean, it doesn’t get any better than that.  It’s the new normal.

      1. Actually, my managerial psychology lecturer said exactly that – that we are all on the spectrum somewhere, and workplaces need a good mix.

    1. Very good, thanks.
      I would amend the author’s caution against the DSM-5 having a significant effect on service delivery in the educational setting. The service delivery is primarily directed by the Individualized Education Plan (IEP) in public schools, it is mandated to be based on function within the school setting, and when used appropriately it is supposed to be a team effort, with the parents as an equal member of the plan. Although clinical diagnosis may certainly be a part of the picture in looking at a child’s needs, it is not the only view of the child that is considered and it doesn’t necessarily take a precedence over any other view an IEP team member has. Its supposed to, when used appropriately say, “Ok, but how do the child’s skills function now, what can be done, and what skills to we want him to have, regardless of label.” But I’ve been lucky to have worked in exemplary school districts, who took the “individualized” portion of the plan seriously, as a civil right.

  8. They changed the label, that is all.

    It makes sense too, autism is a wide and diverse spectrum where m.  Asperger  was a randomly selected sub group.

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